FEC Form 1 for American College of Radiology AssociationForm 1 for American College of Radiology Association

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-140498

1. American College of Radiology Association

1891 Preston White Drive
Reston, VA 201914397
Fax: 703-262-9312
Email: heatherk@acr.org

2. Date: 10/15/2004

3. FEC Committee ID #: C00343459 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

American College of Radiology Association
1891 Preston White Drive
Reston, Virginia 20191
Relationship: sponsored organization
Organization Type: Membership Organization

Custodian of Records:

Phone # 0

Treasurer:

Milton Guiberteau, M.D.
1000 Uptown Park Blvd #253
Houston, Texas 77056
Title: Treasurer Radiologi
Phone # (713) 757-7467

Designated Agent(s):

Lisa Parker Gates
JB Corporation Services
One IBM Plaza
Chicago, Illinois 60611
Phone number = 0

Banks or Depositories

Signed: Milton Guiberteau, M.D.
Date Signed: 10/15/2004
Official Committee FAX: 703-262-9312

FORM TEXT

(End FEC FORM 1)

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